Reproductive FreedomFinding the best birth control option for you

As medical science makes progress, pregnancy prevention is becoming simpler, more reliable and with less side effects. While no method of birth control is perfect, having control over our fertility has never been more accessible.

More than 20 different options for contraceptive methods now exist. Numerous reliable sources of information about contraception are available on the Internet. Whether a woman is in her teens or approaching menopause, she should have a conversation with her family doctor about ways to prevent pregnancy. Even in this day and age, close to half of all pregnancies are not intended. Up to 40 per cent of unexpected pregnancies end in abortion. Different women explore different options for very different reasons.

This excellent Canadian website contains reliable information about birth control.

IUDs and hormonal implants

Women appear to be most concerned with how well a particular birth control method will prevent pregnancy. Currently, the most reliable, easy to use and long lasting yet reversible method is the Intrauterine Device (IUD) or hormonal implant. An IUD with a hormone (Levonorgestrel) is over 99 per cent effective. An IUD without a hormone, such as the Copper T, is also over 99 per cent effective.

The stories of Joanne and Katie explain why a hormonal IUD is the best option for them.

Joanne

Joanne is a 43 year-old mom of two boys who does not plan to have any more children. After her periods became a bit heavier over the last few months, her family doctor found her issues were due to fibroids in her uterus (womb). While these growths are not cancerous and are very common, they can cause heavier and more painful periods. To date, Joanne and her husband have used condoms to prevent pregnancy. However, Joanne would like an even better method of contraception. She wants to avoid taking pills every day. Nor does she like the idea of surgery, such as a tubal ligation for herself or a vasectomy for her husband. Joanne’s family doctor suggests that an IUD may be her best option. A hormonal IUD such as Mirena can be inserted into the uterus in a quick procedure at the family doctor or gynecologist’s office, without a need for anesthesia. It is a plastic T-shaped device about a size of a toonie that glides into the uterus and stays there for about five years. The progesterone hormone in this device works locally on the lining of the uterus to prevent pregnancy. This hormone also makes periods much lighter, which is an excellent way to manage heavier periods caused by fibroids. The Mirena IUD is designed to provide contraception for five years. It can be removed at any time if Joanne does decide to have another baby..

Katie

Katie is a 21-year-old university student who does not plan to start a family for at least a few more years. Katie has already tried taking oral contraceptive pills. Although she was usually excellent at taking one every day, she did forget to take it for a few days during busy exam time four months ago. She was sexually active with her boyfriend at the time. Once she realized that she did not take her birth control pill as prescribed, she was very worried that she could be pregnant. Luckily, Katie’s pregnancy test was negative. Still, this stressful incident prompted Katie to ask about other forms of contraception. Her family doctor suggested a hormonal IUD, slightly smaller than the Mirena IUD and with less progesterone in it. This IUD is made to last three years and is less expensive than Mirena. It is intended for younger women who do not have concerns about very heavy periods. If Katie chooses this form of contraception, she will not have to worry about unplanned pregnancy for three years. It would allow her to avoid the stress of remembering to take a birth control pill every day.

Injectable hormones, pills, patches and rings

Hormonal methods of preventing pregnancy have been available for decades. Medical research showed that women do not need to use as high a dose of hormone as previously thought. Smaller doses mean fewer side effects. Often two hormones, estrogen and progesterone, are combined in one method. This is no longer limited to just the daily pill, but also comes as a weekly patch or monthly vaginal ring.

Progesterone-only options are available as a pill, or can be injected every three months. These methods are considered more than 90 per cent effective if used exactly as prescribed. Some women may not be good candidates for the estrogen-progesterone hormone combinations due to certain personal or family medical history, for example a family history of clotting disorders.

For Grace and Gloria, one of these methods seemed best.

Grace

Sixteen-year-old Grace is a high school student who recently started dating. Although she has never had intercourse, a few of her friends have. Grace is not sure how she feels about potentially being sexually active. Her mom, Virginia, is very concerned about the threat of unplanned pregnancy because she herself became pregnant in high school. Virginia made the difficult decision to have an abortion, and does not want Grace to go through the same thing. Grace also has acne on most of her face. She has tried a few over-the-counter remedies with only a slight improvement.

Grace’s family doctor suggests an oral contraceptive pill with both progesterone and estrogen hormones in it. This may help Grace’s acne, and would prevent an unplanned pregnancy if she does become sexually active. Grace is a responsible teen. She thinks that if she sets a reminder alarm on her phone, she will not have any trouble remembering to take the pill every day. She takes the prescription, and agrees to return for a follow-up visit in two to three months. This will allow her doctor to check whether Grace is happy with her birth control pill, and if she remembers to take it every day at the same time. If after the trial Grace decides that remembering to take the pill every day is more difficult than she thought, they can review other options together..

Gloria

Gloria is a 31-year-old teacher. Three months ago, she gave birth to a healthy baby boy and is nursing him exclusively. Gloria’s period has not returned yet, but she knows that she can still become pregnant. Her chances are lower because she is nursing. Gloria and her husband Ben have resumed sexual activity. They are not ready to become pregnant again and so were using condoms. Three weeks ago, the condom broke. The couple realized that they would appreciate another form of contraception, just in case.

Before she became pregnant, Gloria took birth control pills. However, she heard from a friend that she can’t take the pill while nursing. Her family doctor confirms that taking the usual progesterone and estrogen oral contraceptive pill might affect Gloria’s milk supply. A better option might be a progestin-only pill. It would prevent pregnancy and make Gloria’s periods much lighter when they do return. It is a very popular method of contraception for nursing mothers, and should be taken at the same time every day. Gloria’s family doctor tells her that once she and her baby are ready to stop nursing, Gloria can restart her regular oral contraceptive pill.

Barrier methods and fertility awareness

Condoms are accessible to virtually anyone. They are made for both men and women in male and female versions. Condoms are available without a prescription and are an excellent means of preventing many sexually transmitted infections and pregnancy. Condoms are about 80 per cent effective when used according to instructions. No other birth control methods can significantly prevent infection. If a woman is not in a monogamous sexual relationship or her partner’s sexual history is uncertain, she should use a condom along with her other birth control method.

Diaphragms, sponges and spermicidal jelly are less effective than condoms in preventing pregnancy. For this reason, they are not as popular with most women these days.

A woman who has a regular period can also map fertile days in her menstrual cycle. During fertile times, she should avoid intercourse or use condoms. This strategy is usually about 80 per cent effective. Withdrawal, where the male partner withdraws from the vagina before ejaculation, is another way to avoid unplanned pregnancy. It is also only about 80 per cent effective when followed carefully.

For women such as Erin and Alice, these methods seem best even though they are less effective.

Erin

Erin is a 49 year-old geologist whose first marriage ended in divorce few years ago. She has met a man that she may want to be intimate with, but doesn’t want to commit to a regular or long lasting contraceptive method just yet. Erin has regular periods and knows she can still become pregnant, though she is getting close to the age of menopause. While condoms are reliable, she wonders if other options are similar. Erin’s family doctor tells her about female condoms, abstaining from intercourse on fertile days, diaphragms, and spermicidal applications.

Alice

Alice, 23, is a university student who is about to get married and have intercourse for the very first time. Although Alice is looking forward to having children soon, she would like to finish her university education before her first baby arrives. Her periods are regular. While Alice does not want to use a contraceptive prescription or barrier method because of her religious beliefs, she still would like control over her fertility. Her family doctor takes time to explain the fertility awareness method to her. By observing changes in her vaginal discharge and body temperature during her menstrual cycle, Alice can map out fertile days when she would be most likely to become pregnant. On those days, she and her husband will not have intercourse.

Surgical methods

Tubal ligation in a woman and vasectomy in a man are very effective ways to prevent unplanned pregnancy. However, they are considered permanent and require surgery. For Richard and Marie, and for Lorrie, surgical methods are preferable.

Richard and Marie

Richard is a 42 year-old truck driver and a father of four school-aged children. He is married to Marie, a 40 year-old stay-at-home mom. Richard and Marie decided together that they do not want to become pregnant again. Marie experiences migraines with auras and has high blood pressure. This means she should not take estrogen-progesterone combination pills, or use patches or vaginal rings. Marie tried a hormone IUD, but her doctor removed it after a month when she started having new pelvic cramping that did not go away. Marie did not want to try the IUD again, and asked her doctor about tubal ligation. After a longer discussion of options, the family doctor suggested that Richard consider a vasectomy. It is almost as effective as a tubal ligation, but much simpler to perform and with far fewer surgical risks.

Lorrie

Lorrie, 39, is a store clerk. She has been in several relationships with male partners and does not wish to ever have children. Earlier in life, Lorrie became pregnant while taking a birth control pill. This was very stressful and ended with a therapeutic abortion. As a result, she does not want to use a hormonal method of contraception. Lorrie considered using an IUD until menopause, but finally decided on tubal ligation. She likes the idea that it’s a permanent treatment. Her family doctor refers her to a gynecologist to perform the surgery.

No birth control method is perfect or completely reliable. However, a wide variety of available choices allow women and their partners to choose when and if to start a family. Talk to your doctor about which options might be right for you.